Tuesday, 12 Dec 2017

You are here

TNF Inhibitors Increase Perioperative Infection Risk

The use of tumour necrosis factor α inhibitors (TNFis) at the time of major surgery has been a challenge for surgeons, rheumatologists and those wishing to develop evidence-based guidelines for this clinical scenario. While studies have shown that TNF inhibitor treated patients are at greater risk for perioperative infections, other studies have also shown that cessation and drug-washout may be associated with rebound inflammation that further drives the infectious risk. Goodman and colleagues from the Hospital for Special Surgery have done a systematic review of the impact of TNFi exposure on surgical site infections in RA patients undergoing elective orthopaedic surgery.

They identified 8 observational studies and 3 case control studies meeting inclusion criteria that included 3681 TNFi-exposed (TNFi+) and 4310 with no recent exposure to TNFis (TNFi−) at the time of surgery. The TNFi+ group had higher risk of developing surgical site infections compared with patients in the TNFi− group (OR 2.47; 95% CI 1.66, 3.68); P < 0.0001).

Thus, TNFi exposure at the time of surgery increased risk of surgical site infections in RA patients. The role of other infection risk factors (disease activity, corticosteroids, smoking, comorbidities) was not assessed in this analysis. 

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Why TNF Inhibitors May Work in Some Autoinflammatory Patients

The NLRP3 inflammasome is a critical component of the innate immune system and activation of NLRP3 inflammasome results in caspase-1–dependent secretion of the proinflammatory cytokines IL-1β and IL-18. Gain-of-function missense mutations in NLRP3 is thought to drive many of the autoinflammatory diseases, especially the cryopyrin-associated periodic syndromes (CAPS).

Infliximab Does Not Increase Perioperative Infection

Staying on a TNF inhibitor (TNFi) throughout major surgery has generatlly been associated with higher rates of perioperative infection (https://buff.ly/2iBFVjp).  On the other hand, discontinuation of the TNFi prior to surgery is associated with lower rates of  infection (https://buff.ly/2iAFZQf)

CALM Study: Tight Control with Anti-TNF Wins in Crohn's Disease

Not unlike rheumatoid arthritis and other inflammatory disorders, therapeutic efficacy in Crohn's disease (CD) is often assessed clinically. There is growing use and interest in biomarkers of intestinal inflammation, such as faecal calprotectin and C-reactive protein. But Lancet has now reported a clinical trial has shown that a tight control strategy can yield better responses to TNF inhibitors when compared to usual care. 

Amgen-Abbvie Settle Humira Biosimilar Patent Dispute

Amgen's biosimilar version of adalimumab (Humira) was FDA-approved in September 2016 and given the trade name Amjevita (generic: adalimumab-atto). This new TNF inhibitor biosimilar has not yet been to market because of legal wranglings over patent issues by Abbvie's Humira.

Another Adalimumab Biosimilar Approved

On Friday August 25th, the FDA approved another adalimumab biosimilar: Cyltezo (generic name: adalimumab-adbm).